Today, the President endorsed the consumer bill of rights and responsibilities recommended by the Advisory Commission on Consumer Protection and Quality in the Health Care Industry. He stressed that the Commission's recommendations provide an excellent framework for long overdue national standards of consumer protection.
In accepting the recommendations, the President: (1) challenged all private health plans to adopt the Commission's consumer bill of rights; (2) called on Congress to pass appropriate Federal protections into law; and (3) directed every federal agency that administers or manages health plans to adopt the protections of the bill of rights and to advise where they need additional legislative authority to do so.
The President:
(1) CHALLENGED ALL PRIVATE HEALTH PLANS, PROVIDERS, AND HEALTH CARE FACILITIES TO ADOPT THE CONSUMER BILL OF RIGHTS. To take immediate steps to ensure that all affected stakeholders adopt the Commission's recemmendations, the President called on these parties to adopt the bill of rights. A voluntary call for compliance will not ensure that all Americans have access to these rights, but it represents an important first step.
(2) CALLED ON ALL PARTIES TO MAKE THESE RIGHTS REAL. To make these rights real for all Americans, the President called on Congress to pass the appropriate Federal protections into law before the 105th Congress adjourns. Some of these rights can be ensured administratively and some can be ensured through private accreditation, but clearly some will require Federal legislation. The President looks forward to working with the Commission and all other interested parties to work with the Congress in developing the appropriate balance of private, administrative, and legislative approaches. Republicans and Democrats alike have supported legislation providing consumer protections, and the President is optimistic that Congress will enact a measure he can sign into law in 1998.
(3) DIRECTED ALL FEDERAL AGENCIES TO COME INTO COMPLIANCE WITH THE BILL OF RIGHTS. To ensure that the Federal government takes the lead in providing consumer protections, the President directed the Department of Health and Human Services, the Department of Labor, the Department of Defense, the Department of Veteran Affairs, and the Office of Personnel Management to review the programs they administer and the plans they oversee to ensure they are consistent with the bill of rights. He instructed the agencies to exhaust every administrative action to make the programs they administer and the plans they oversee consistent with the bill of rights. He asked them to indicate what statutory limitations impede their ability in this regard. The President directed these agencies to report back to him through the Vice President on the status of this directive by February 1998.
The Commission's consumer bill of rights consists of the following rights and responsibilities:
(1) Access to Accurate, Easily Understood Information about health plans, facilities, and professionals to assist consumers in making informed health care decisions;
(2) Choice of Health Care Providers that is sufficient to ensure access to appropriate high quality care. This right includes providing consumers with complex or serious medical conditions access to specialists, giving women access to qualified providers to cover routine women's health services, and ensuring continuity of care for consumers who are undergoing a course of treatment for a chronic or disabling condition;
(3) Access to Emergency Services when and where the need arises. This provision requires health plans to cover these services in situations where a prudent layperson could reasonably expect that the absence of care could place their health in serious jeopardy;
(4) Participation in Treatment Decisions including requiring providers to disclose any incentives -- financial or otherwise -- that might influence their decisions, and prohibiting gag clauses that restrict health care providers' ability to communicate with and advise patients about medically necessary options;
(5) Assurance that Patients are Respected and Not Discriminated Against, including prohibiting discrimination in the delivery of health care services based on race, gender, ethnicity, mental or physical disability, and sexual orientation;
(6) Confidentiality provisions that ensure that individually identifiable medical information is not disseminated and that provide consumers the right to review, copy, and request amendments to their medical records;
(7) Grievance and Appeals Processes for consumers to resolve their differences with their health plans and health care providers -- including an internal and external appeals process; and
(8) Consumer Responsibilities provisions that ask consumers to take responsibility by maximizing healthy habits, becoming involved in health care decisions, carrying out agreed-upon treatment plans, and reporting fraud.
The President created the 34-member Advisory Commission on Consumer Protection and Quality in the Health Care Industry on March 26, 1997, charging it with recommending such measures as may be necessary to promote and assure quality and value and protect consumers in the health care industry. The Commission is co-chaired by Secretary of Labor Alexis Herman and Secretary of Health and Human Services Donna Shalala. The Commission will submit its final comprehensive report on creating a quality framework to the President, through the Vice President, on March 30, 1998.
Last spring, when I appointed the members of the Advisory Commission on Consumer Protection and Quality in the Health Care Industry, I specifically charged them to develop a consumer bill of rights. This period of rapid change and experimentation in the way Americans receive and pay for their medical care holds the promise for improved quality, greater choice, and lower expense. At the same time, we must identify and protect certain fundamental rights of patients and their families so that, whatever health care delivery system they choose, they can obtain the information and care they need when necessary. Health care consumers also need to understand their responsibilities in a changing health care environment to ensure that they get the best possible care. Confirming such rights and responsibilities is critical to ensuring that the quality of medical care does not suffer as we seek to expand access and improve efficiency of delivery.
The Consumer Bill of Rights and Responsibilities in Health Care, issued today by the Commission, fully lives up to my high expectations. The members of the Commission have brought to bear their own considerable abilities and have obtained information from a wide range of sources. This Bill of Rights and Responsibilities is a comprehensive and thoughtful document that will be an excellent guide as we move through this transition in health care delivery. We must take steps to see that the rights contained in this document become a reality for all Americans.
Therefore, I hereby direct you to take the following actions consistent with the mission of your agency.
First, I direct you to determine the extent of your current compliance with the recommendations of the Commission.
Second, I direct you to use your administrative authorities, including existing regulations, advisories, and other guidance regarding health plans under their respective jurisdictions to initiate appropriate administrative actions consistent with the recommendations of the Commission.
Third, I direct you to identify the statutory impediments to compliance with the recommendations of the Commission.
Finally, I direct you to report back to me, through the Vice President, by February 19, 1998, with your findings and the administrative actions you have already undertaken and will undertake to effect the Commission's recommendations.
WILLIAM J. CLINTON
THE PRESIDENT: Thank you very much, first of all, Peter, for your outstanding remarks and the power of your example. And I accept your offer to play golf. (Laughter.)
I thank all the commission members and the members of the staff for a truly remarkable piece of work. And I'd like to say a special word of appreciation to Secretary Shalala and Secretary Herman, who cochaired the commission and who, I believe did a remarkable job and I thank you very much. (Applause.)
I thank the Vice President for his work in overseeing this effort and for his concern.
This whole health care issue is very personal to me and to our family, to the First Lady. When I was running for President I met person after person after person who had a cost, a quality or an accessibility issue with the health care system. But long before that, as a governor in what my opponents used to call a small southern state, I had the great gift that representing a small population gives you, of knowing a high percentage of the people who hired me -- from all walks of life and all social strata, from all different circumstances.
And I just kept -- I had such ambivalent feelings. I could see in my own state that we had the finest health care system in the world. I saw miracle after miracle after miracle; I saw person after person given a chance to reconstitute his or her life -- and then all these terrible problems arising from the cost or the quality or the accessibility issues.
So we've worked very hard on them. The Vice President mentioned the quality issues. I would also like to say, this has been a very good year across the board for American health care. In the balanced budget bill we have $24 billion to provide health insurance to another 5 million children, about half of those who don't have health insurance -- something that has become very important because the number of uninsured Americans has continued to rise since 1993. Ironically, even as the percentage of people in the work force eligible to purchase health insurance with the involvement of their employers has gone up because of prices, the coverage has gone down.
We had a significant step in reforming the Medicare program to add many years of life to the trust fund and provide more choices, including preventive care to Medicare recipients and earlier tests for mammographies for younger Medicare-eligible women. We had what the American Diabetes Association called the most significant advance in the care of diabetes since the discovery of insulin 70 years ago in this bill. We will -- in a day or so, I'm going to sign the bill reforming the Food and Drug Administration and its procedures. The FDA, I might point out, has already won an award for its groundbreaking work in accelerating the approval of drugs while continuing to meet safety standards to try to increase the availability of possibly life-saving medication more quickly.
So a lot of good things happen. Yesterday, I signed an adoption bill which was the product of an overwhelming bipartisan consensus in Congress which will revolutionize adoptions, including adoptions of children with special needs, which also will have a terrific health impact on some of the most vulnerable children in this country. So I want you to see this commission's work against that backdrop. There is an emerging consensus in America that while people may not have wanted to bite the whole apple at once in 1994, almost the whole populace wants to keep nibbling away at the apple until we actually have solved the problems of cost, accessibility and quality for all responsible American citizens.
What this commission has done today with their Health Care Consumer Bill of Rights is a truly extraordinary thing -- all the more extraordinary because the commission actually represents all walks of life and all the different financial equities in the health care debate in America. And again, let me say, I thank you very much. We will be much closer to making these rights reality for every American because of the courage of the commission and because of the composition and the broad experience of the different commission members.
Throughout our whole history, our strength has come from our families, from our individual citizens, from our continuing commitment to redefine and expand the parameters of opportunity and freedom, and at the same time, to do it in a way that brought us closer together as a society instead of dividing us further. Those values were in America's Bill of Rights, and they are certainly in this Health Care Consumer Bill of Rights.
Today, our families face so much change and, of course, the changes in the way we work, the way we live, the way we relate to each other and the rest of the world are quite profound. I think, in a major way the mission of our administration here must be to try to help America prepare for these changes so that we can expand the opportunities they present and adequately meet the challenges they present, and so that we can go forward together.
Health care is changing dramatically, as we all know. The Vice President detailed some of those things. And we have worked hard to help people deal with these changes. Now, there are still particular problems that plainly require specific solutions. Millions of Americans have seen their health plans convert to HMOs and new kinds of health insurance. In many cases, managed care does bring lower costs and improved preventive care, and the health care industry, I believe, as a whole truly shares our goals of improving quality. And I have never been one who believed that improving efficiency involved the sacrifice of quality and, often, not even a sacrifice of quantity.
Our administration has reduced the size of the federal government by 300,000, eliminated a few hundred programs and several thousand pieces of legislation, and I have yet to have a single American citizen come up to me and say, why did you get rid of this or that. So we believe that you can have efficiency and improve quality and often improve the sheer volume of service, as well. That's one of the things that technology makes it possible for us to do.
Still, I think it's fair to say that almost every family feels some insecurity at the scope and pace of change in the world, including the scope and pace of change in the health care industry. And very often people feel actually lost because they have come up against this change in a way that is, to be charitable, not positive.
There are so many people in this country that because of these changes feel like they're always going to be on the losing end of cost-cutting and quality issues in every sector of life, maybe even where they work, and they certainly are most frightened of it when it comes to health care -- even more frightened than when it comes to their own job, I think, because with the unemployment rate being low and real flexibility in American labor markets, Americans have proved that they are incredibly resilient at getting new jobs, and increasingly, those new jobs are as good or better than the ones they lost -- something that was not true just a few years ago. But when it comes to health care, you can't be sure of that kind of recovery, and no matter how much confidence you have in your own resilience, somebody else has got to help you.
So even if we are trying to give Americans more job security in a changing environment by keeping unemployment low and intensifying our efforts to help people if they do lose their jobs to get better skills and find a job that is as good or better, we have got to recognize that the elemental insecurity that a loss of confidence in the quality, the accessibility or the affordability of health care can breed in our society is staggering.
The flip side of that is that if we can address those concerns, they increased confidence people have in the stability of the society as it affects their family and their lives will make them immeasurably more able to deal with the challenges of technology and globalization and change that no one can repeal.
So I don't think it is possible to minimize the peripheral impacts, positive impacts of having the right kind of consumer bill of rights in health care -- and how much it will do to the sense of stability people feel on the job; how much it will do to increase employee productivity when they're not worried about their husband or their wife who got cancer three years ago, or if they're not worried about what's going to happen if their kid is in a car accident, like Peter was. If they know that at least they're going to have the best chance they can get it will have a terrific impact to stabilize and sort of harmonize our society in ways that I think will be immensely positive for the economy. And, obviously, the business leaders on this commission agree.
Now, consider the consumer protection issue in the larger context. Today, Americans receive consumer protection when they purchase cars, use credit cards, buy toys for their children. All this commission is recommending is that we extend that kind of protection when a person visits a doctor, checks into a hospital or buys into a health plan. Whether it's traditional health care or managed care, we have to make sure it's not inferior care. There are basic standards that I believe every American should be able to count on wherever they live, whatever their needs. Those standards ought to be the right of every citizen.
Here is what the Health Care Consumer Bill of Rights says: You have the right to be informed about your health plan in plain English. You have the right to choose the right doctor for the right type of care; the right to medical services in an emergency wherever and whenever the emergency arises; the right to know all your medical options, no matter how much they cost; the right to respectful care and equal treatment at every health care facility by every health care provider; the right to know your medical records are confidential and only used for legitimate purposes; the right to express your concerns about the quality of care you receive and to take action when that care is inadequate.
This Consumer Bill of Rights, as has already been said, is the product of a broad consensus from a broad group of business leaders and health insurers, working people and health advocates, doctors and nurses. There are still those who oppose it and that is their right. But this is a case where the national interest must prevail over the narrow interest, where the family's interest must prevail over the fear of change.
I ask those who are afraid, on the other side, to balance in their equation the fear that has been in the hearts of all the Americans who have confronted the health care system without this Consumer Bill of Rights. We all have to bear our fair share of the uncertainty of change if we are all going to feel secure in the face of the future. And that seems to me to be the best argument that we can take to those who do not yet agree that this is the right thing to do.
These protections, in fact, are long overdue, and now we have to act to make them real for all Americans. Some will require federal standards to be implemented. Where they do, I challenge Congress to make them the law of the land. There will be no more important tests in the coming months of our commitment to strengthen our families. And I look forward to working with Congress.
You heard the Vice President say there's broad bipartisan support for moving forward here. But we shouldn't wait for Congress to act, especially when it's not necessary. So today I am acting within my power as President to implement the rights to the extent that I legally can. I'm directing every federal agency that administers or manages health plans to adopt the protections of the Consumer Bill of Rights, and to report back to the Vice President about where they need legislation to do so. With this step we can ensure better quality health care for tens of millions of Americans, including all Medicare and Medicaid beneficiaries, and all federal employees. And I challenge all private health plans to adopt the Consumer Bill of Rights voluntarily, to give their members greater confidence and security.
In that connection, I want to thank GTE and one of our commission members, an officer of GTE, Randy McDonald. They are the first large company to guarantee the Consumer Bill of Rights to all the 400,000 people on their health plan, employees and their family members. It's an extraordinary step. And if they can do it, others can follow. I don't know if Randy is here today, but if he is, will you stand up? Thank you very much. God bless you. (Applause.)
Finally, it would be wrong or us to end this without acknowledging that there can be no rights without responsibilities; that our community can only go forward when there is a corresponding responsibility for every opportunity and every right.
The new world of health care offers greater choice and more fundamental opportunities for health than ever before. And today, we outlined the rights that every American should have in dealing with that health care system. But every American also has an enhanced obligation to take an active role in his or her own health care and to take responsibility for his or her own health. We spend a lot of money in this country every year that we wouldn't spend if we'd just go through the day in a sensible way every day. And we have to acknowledge that, and we cannot blame the health insurance industry or the health care providers or anybody else in the wide world for the burdens we impose on ourselves for the extra cost, the lower income, the reduced productivity that are the direct result of daily choices made by individual citizens that they do not have to make in the way they live their lives, and we ought to be honest about that.
And we should never point the finger at other people when we have problems until we have first examined ourselves and what we have to do. And I know a lot of companies are looking at ways to reward responsible behavior and ask that some payment be made for that behavior that imposes costs on society as a whole. That's a large part of what we're attempting to do in settling this issue of the marketing and selling of tobacco to young people in America in ways that violate our laws. So I think that has to be a part of this; we can never lose sight of it.
When President Kennedy proposed a Consumer Bill of Rights over 30 years ago, he said, "Under our economic as well as our political form of democracy, we share an obligation to protect the common interest in every decision we make." I am convinced, as I have said repeatedly, that the coming years will be a time of remarkable breakthroughs in science and medicine, remarkable breakthroughs in the space and in the ocean, remarkable breakthroughs in the structure of human genes. There will also be a time of remarkable opportunity to relate to other people around the world, economically and culturally. They can be, this next 50 years, the best half-century human society has ever known. But we have to look after the common interest. No matter how individualized our computers, our telephones, our fax machines, our self-employment -- no matter what happens, we will still have to protect the common interest is we want to have safe streets, good education, good health care, a clean environment and a healthy economy.
Today, by standing up for individual rights, this commission has advances the common interest, and America will be much better for it.
Thank you very much. (Applause.)
END
12:29 P.M. EST
The Briefing Room, 1:10 P.M. EST
MR. TOIV: Good afternoon, everyone. Before Mr. McCurry comes out for his daily briefing, we have the co-chairs of the Advisory Commission on Consumer Protection and Equality in the health care industry who can answer any questions you might have on the President's call -- Secretary Shalala and Secretary Herman are here to answer any questions you might have on the President's call this morning for a Consumer Bill of Rights and Responsibilities. Glad to take your questions.
SECRETARY SHALALA: Thank you very much. Questions?
Q How quickly are you going to move to implement the rights under respective departments -- how quickly can you move?
SECRETARY HERMAN: Well, I think the -- on two fronts. Obviously, the announcement this morning by the President that the GTE Corporation has already endorsed the Bill of Rights and Responsibilities and that Bill of Rights will now apply to more than 400,000 participants in the GTE employer family system indicates that from a voluntary standpoint point of view, that clearly employers and others can start to move out right away.
The President directed all of the executive branches now to go back and to examine what is in the Bill of Rights and Responsibilities and to report back to him on what we can do to take action on what has been presented. I would assume that we can begin to do some things right away because you don't need --
SECRETARY SHALALA: Well, in fact, the Medicare program already contains a lot of these rights already, so what we need to do is to go systematically through our programs. Now, this involves the Department of Defense programs, the Veterans Administration programs, as well as HHS and whatever appropriate responsibilities that the Labor Department has. We expect to report back to the President sometime in February.
Q Secretary Shalala, with all these recommendations that the President has embraced, should they become law, how are you going to prevent a litigation explosion?
SECRETARY SHALALA: Well, I think that the point is to avoid a litigation explosion. If you look, for instance, at making certain that appeal rights are within a health plan or a hospital and making sure that people know what those rights are and that they try to settle whatever concerns they have within their own health plan or within their hospital or nursing home, and if they can't a very small number will go to an outside system set up by the states. I mean, the point of all of this is to make sure that the information is there so that people are clear about what their plan offers and to reduce litigation. In fact, I'd argue that this is moving in the other direction, to reduce legislation.
SECRETARY HERMAN: I think it's important to point out that we actually heard testimony on this yesterday in the commission meeting, and one of the clear indications is that when consumers have information, when they know their rights and they're able to get the information that leads to better quality, that leads to more efficient systems, that the reality is you can in fact reduce the burdens of litigation on any one system.
Q So somebody who doesn't -- because one of the appeals essentially says if I don't like the way I'm being treated I can appeal this process, but eventually something like that could lead to litigation. If you don't feel you're getting a respectful quality of care or whatever and the providers --
SECRETARY HERMAN: But you can do that now. I mean, an individual, technically, could proceed down a path of litigation right now without having, quite frankly, the information that they're trying to essentially get oftentimes through a litigation process that now this Bill of Rights calls for in terms of disclosure.
Q Secretary Herman, do you support what's in the Charlie Norwood's bill that would allow consumers to sue plant managers if they make a medical decision that goes bad on them?
SECRETARY SHALALA: We haven't taken a position on any of the legislation. We will use this Bill of Rights as a framework to examine that legislation. But in addition to that, we're talking about some of this could be incorporated as part of an accreditation processes. We're looking at our own regulations; some of it may be voluntary, as we saw today with the GTE company.
Q Is that something the administration is planning to act on and will you take a position on this bill eventually?
SECRETARY HERMAN: Presently, the administration has taken no position. Obviously, the administration is looking at all of the various proposals that are presently being debated on the Hill, but we have not taken any position to date yet.
Q You just mentioned that some of this can be done through the private accreditation process. But what parts of the bill of rights do you think will have to be legislated to guarantee that Americans are protected by these provisions?
SECRETARY SHALALA: Well, we will, in fact -- the President has now asked us to do that review. I know of one piece now -- privacy. We have privacy proposals up before Congress, and I think everyone would say that using health care records for health purposes and making sure we have privacy protections.
We have no federal privacy protections for health care information now in this country. There are more protections on your Blockbuster card and on your motor vehicle license than there are on your health care card. There is one pretty narrow example. But that's the only one that comes to mind, and we will be going through a review.
Q Is it right to look at this bill of rights as kind of a minimum national set of standards that states can go further, if they wish?
SECRETARY HERMAN: I don't know that I would use the term, necessarily, minimum set of standards. What I think we have here are a set of operating principles that we're saying all consumers are entitled to, in terms of their basic fundamental rights in the health care system.
And I think of it more in terms of a clear set of operating principles that we've laid out for states, for Congress, for employers, for everyone who is a stakeholder in this issue to hopefully adopt.
Q If a state wants to pass laws setting higher standards than this panel recommended, there's nothing that would discourage them from that?
SECRETARY HERMAN: Well, clearly, I think, you have states that are already taking the lead in different ways in this area that certainly we would want to encourage and see how the states follow.
We had testimony in this commission meeting on various states, for instance, who were doing things differently in the complaints and appeals process. I think New Jersey is a good example of that.
Q What do you say to the one dissenting member of the commission, who contended that these recommendations would cost small businesses too much and could lead to them dropping coverage of their employees?
SECRETARY SHALALA: You're a former small business owner, so why don't you answer that?
SECRETARY HERMAN: I think certainly we heard the sentiments that were expressed by our commission member regarding her own point of view. One, I point out that there clearly were other small business members on this commission who, in fact, did endorse the recommendations as well as the cost estimates that were provided to the commission members, and they certainly recognized and believed that the proposals that were being made were proposals that needed to be made, that the costs were very much in line with what we were proposing and that small businesses could deal with, and the other reality is that sometimes when you put more efficient systems in place, it actually can lead to cost reduction. I think that was left out of the debate.
And I can just say as a former small business owner myself, this was an issue that I was particularly sensitive to as we went through the discussions because many of those individuals that we certainly want to take advantage of these recommendations are, in fact, small businesses. It's the employers. Most people get insurance today in the workplace, and so for us to be sensitive to the needs of small business was very much a guiding principle throughout these discussions.
SECRETARY SHALALA: I would look at it slightly in an additional way, and that is that every health plan, every hospital, every nursing home adopts the Consumer Bill of Rights, whether it's a combination of accreditation and licensing or state regulations or whatever way they get it, it empowers a small business, because it gets them something they can't get now because they're too small of a purchaser.
So one way of looking at this is that for small businesses, for them to be able to get this kind of information and appeals processes for their employees, they can't do it as a small business. But if we get it into all the plans and all the other parts of the health care system, they get it along with everybody else. So we think, in fact, it strengthens the hands of all businesses in this country for their employees.
SECRETARY HERMAN: But I'd say especially small businesses when we talk about strengthening the hand of employers.
Q But do you reject the argument that this will raise costs?
SECRETARY HERMAN: We don't reject that. As a matter of fact, we had proposals presented to the commission yesterday that, in fact, stated we believe a very modest cost figure.
SECRETARY SHALALA: The average cost was .84. What the quick and dirty study that Lewin and Associates, which was reconfirmed by one of the business leaders at the table who had done a similar study, Randy McDonald from GTE reported they had done a similar study -- the average cost was .84 per health care -- per consumer, per month, .84 per month.
But remember that this commission is not just about consumer rights, it's also about quality. What we're trying to do is to make the whole health care system more efficient. The more information you have, the more effectively you use the system, the more you reduce the amount of litigation so that on the one hand providing these rights, access to information, may initially cost more depending on how much you're doing now -- and most plans are doing some of this -- and the best plans are doing almost all of it.
But on the other hand, anything we can do to use the health care system more efficiently in terms of us having more information about the doctors, about the companies we're going into will also save money. So I think that it would be misleading to the American public to see this just as an add-on as opposed to part of a fundamental change in the American health care system. This is the consumer rights piece; we'll be talking in March about the quality piece, which is a very different way of running and managing the health care system in the United States.
Q Secretary Shalala, the President's pointed out recently that in the three years since the defeat of this universal health care plan, the number of Americans without health insurance has steadily climbed and I believe is now over $40 million. Does this bill of rights do anything to arrest and reverse that trend?
SECRETARY SHALALA: In two ways it will be helpful, but it doesn't directly address the access question. Number one, this bill of rights applies to everyone who uses the health care system whether or not they have health insurance. So if they walk into an emergency room, if they go pay a doctor out of pocket, or go into a hospital, it applies to them. That's number one.
Number two, to the extent that the health care system is more efficient and that we can contain the growth of health care costs, not just in the Consumer Bill of Rights, which allows us to use it more effectively, but in the quality recommendations we'll be making, to the extent that people go to surgeons, for instance, that have done the surgery a lot of times, where they're not only producing more quality, but probably a better cost in the long run, it will affect access to health care in the United States.
But this administration has addressed that issue in a variety of different ways, including the Kennedy-Kassebaum bill on the issues of discrimination and the children's health insurance which will reduce those numbers by at least 5 million.
SECRETARY HERMAN: I would also add to that, though, in relationship to the bill of rights, that I really do believe that by making the system more efficient and by enabling more employers, particularly again as we look at what we can do for small businesses through the recommendations that have been made in this bill, that we help those units in particular to be able to consider, perhaps, because of more efficiency in the system covering additional workers. And in that context, hopefully we can bring more individuals into the system.
Q You were asked which of these provisions would have to be legislated. Sort of the outburst of that -- are there any provisions that you know at this point or can indicate at this point can be implemented without any legislation?
SECRETARY SHALALA: All of them can. All of them can if hospitals and nursing homes and --
SECRETARY HERMAN: Employers --
SECRETARY SHALALA: -- and employers decide to adopt them. If the purchasers of health care, including the federal government, say we're not going to purchase health care unless we have all these Consumer Bill of Rights, all of them can. The most important thing is to get them for everybody, and that's why there's a consideration of accreditation regulation legislation.
SECRETARY HERMAN: And I think to the extent that we have to look at nonvoluntary action, if you will, in this area, it will be related to the need for consistency for all consumers in this area, because clearly you already have some very good HMOs that are doing disclosure, that are providing the kind of information that we're asking for through this Bill of Rights. But not everyone is doing that, so we're concerned about, I think, consistency of effort in this Bill of Rights.
SECRETARY SHALALA: As we leave here, think about in your own health care plans how many of you know, have background information on your doctors in your own health care plans, and how many of you know what rules apply if you disagree with a decision made by your health plan? How do you appeal that process?
When we're finished with this, every single one of you will clearly know that information. That is the fundamental point. We want you to know more about your health care plan to be able to use it more effectively.
Q Thank you.
SECRETARY HERMAN: Thank you very much.
END 1:30 P.M. EST